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Immunisation

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Immunisation is the cornerstone of preventive medicine. Basic diseases (diphtheria, tetanus, polio, whooping cough, measles, mumps, rubella) should be covered. Children should be immunised according to the NHMRC recommendation.

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All adults should receive an adult diphtheria and tetanus (ADT) booster each 10 years.

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All women of child-bearing years should have their rubella antibody status reviewed.

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Table I1

Current recommended schedule (www.immunise.health.gov.au)

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  • Influenza: annually for those with chronic debilitating diseases, persons >65, health care personnel and the immunosuppressed.

  • Hepatitis B: for those at risk through work or lifestyle; infants born of HBsAg +ve mothers.

  • Q fever: those at risk, esp. abattoir workers.

  • Tuberculosis (BCG vaccine): infants at risk (e.g. Indochinese babies exposed to TB, health workers who are Mantoux negative).

  • Pneumococcal vaccine: splenectomised persons >2 yrs, Hodgkin's lymphoma, those at high risk of pneumococcal infections.

  • Meningococcal c vaccine: children and adolescents 15–19 yrs; B strain vaccine is available.

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Impetigo

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  • If mild and limited: antiseptic cleansing and removal of crusts bd with an antibacterial soap or chlorhexidine or povidone-iodine. Apply mupirocin (Bactroban) tds for 7–10 d

  • Daily bath with Oilatum Plus bath oil for 2 wks is helpful

  • If extensive: oral di(flu)cloxacillin or cephalaxin or erythromycin for 10 d (if penicillin sensitive)

  • Exclude from childcare/school settings until fully healed

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Incontinence of urine

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  • Search for a cause:

    • D—delirium, drugs (e.g. antihypertensives)

    • I—infection of urinary tract

    • A—atrophic urethritis

    • P—psychological

    • E—endocrine (e.g. hypercalcaemia); environmental: unfamiliar surrounds

    • R—restricted mobility

    • S—stool impaction, sphincter damage or weakness

  • Avoid various drugs (e.g. diuretics, psychotropics, alcohol)

  • Weight reduction if obese

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In women:

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  • perform urodynamics to assess stress incontinence

  • bladder retraining (instruct patient to delay micturition for 10–15 mins on impulse to void) and pelvic floor exercises (mainstay of treatment)

  • physiotherapist referral

  • consider a trial of anticholinergic drugs if bladder atony instability or voiding dysfunction (e.g. solifenacin 5–10 mg daily, propantheline 15 mg (o) bd or tds, tolterodine 2 mg (o) bd)

  • consider surgery for ...

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